Журнал клинических случаев

Objective: The construction of a predictive model that improves the estimation of the fetal weight (EFW). Study Design: a comparative, descriptive study. One hundred forty pregnant women were recruited at two-stage sample in health department in Spain. They were classified in four groups depending on the pre-gestational BMI. Fetal weight was estimated by ultrasound at 35-40 weeks (EFW40w) by one gynecologist. A regression model was created with the variables that reacted to the newborn´s weight, symphysis-fundal height (SFH), EFW40w, gestational age (GA), ferritin level and cigarettes smoked. Results: A multivariatel model was created for the NW group to estimate the fetal weight (EFWme), resulting in R2=0.727 (p<0.001). The differences of the averages obtained between EFW40w and EFWme, with the new born´s weight were significant (p<0.001). EFWme underestimates birth weight by 0.07 g (mean error 0.53%), and EFW40w overestimates it by 300.89 g (mean error 10.12%). In order to evaluate the predictive model and verify the predictions we used the Bland-Altman analysis. The average error in estimating the birth weight with EFWme was 1.94% underestimating the result, whereas the ultrasound error overestimated the result 10.93%. Conclusion: The multivariate model created for the NW group improves the accuracy of the ultrasound.

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A 46 year old man presented with proptosis of the left eye. Extensive explorations revealed undifferentiated nasopharyngeal carcinoma.

12-year-old girl with a history of acute lymphoblastic leukemia,but without previous evidence of central nervous system involvement, presented with sudden, painless loss of vision in both eyes 3 years after complete remission. Her best-corrected visual acuity was 1/6 in the right eye and 2/6 in the left eye.

In the 1960s and 70s hip arthroplasty was in its infancy. During that time the occurrence of post-operative prosthetic femoral stem fracture was much greater than it is today. However as stem design and materials evolved along with superior cement and cementing techniques, rates of femoral stem fracture radically decreased, at present it is considered a rarity. We present two cases of fractured prosthetic femoral stems, detail the method of failure and the risk factors all surgeons should be aware of to minimize the risk femoral stem fracture.

Upper urinary tract squamous cell carcinomas are uncommon tumors. Several risk factors have been identified with this entity. We present a case primary squamous cell carcinoma of the distal ureter in an individual with no identifiable risk factors. The patient is a 70 year-old man who presented with bilateral flank pain. Laboratory investigations showed high serum creatinine. There was left hydronephrosis on ultrasonography. Computed Tomography (CT) showed an ill-defined soft tissue mass in the left ureter. A left retrograde pyelogram revealed a mass 4 cm from the ureterovesical junction, with ureter dilation proximal to it. The patient underwent distal ureterectomy and stented ureteroneocystostomy. Pathological study of the tumor revealed a moderately differentiated stage 3 invasive squamous cell carcinoma. On serial follow up, the patient showed significant improvement of the left hydronephrosis and improvement of the renal function. Two-year follow-up was negative for recurrence.

Phyllodes tumours are rare biphasic breast lesions that generally occur in older women than fibroadenomas. We report case of a 14 year old girl who presented with a 1 year history of an ulcerated fungating left breast mass that required mastectomy. The general lack of awareness of breast disease in our community or knowledge of available therapies is discussed. The relevant literature is also reviewed.

Anal mucosal melanoma constitutes only 0.5 to 2% of all anorectal malignancies and less than 2% of all melanomas. Anal melanoma is the third most common melanoma after the skin and ocular varietiesand the most common site for primary gastrointestinal melanoma.

Tuberculosis is caused by Mycobacterium tuberculosis and affects primarily the lungs. Breast tuberculosis is a rare disease with an incidence of <0.1% of all breast lesions in Western countries and 3-4% in tuberculosis endemic regions, such as India and Africa.

Bowel preparation is known to cause minor electrolyte disturbances. We report the case of a patient with severe hyponatraemia and hypokalaemia, resulting in a seizure, following the administration of picolax. A 60 year old female patient with no significant past medical history and taking no regular medications presented with confusion following administration of picolax for an elective colonoscopy. On arrival her GCS was 14/15 but moments later she had a tonic-clonic seizure, with no urinary incontinence or tongue biting lasting two minutes. Following this, her GCS was 9/15. Laboratory tests revealed a sodium level of 119 mmol/L and a potassium level of 3.1 mmol/L. Other investigations including CT head and lumbar puncture were normal. Following intravenous replacement of electrolytes, her electrolytes improved and GCS returned to 15/15. Severe hyponatraemia, hypokalaemia and associated seizures following bowel preparation are rarely described in the literature. There are only five reported cases of severe electrolyte disturbances following bowel preparation that have caused seizures. We urge care to be taken when prescribing bowel preparation; particularly in those with pre-existing medical conditions and taking medications which can cause hyponatreamia, and to council patients when prescribing bowel preparation on the side effects.